[Teratogenicity information is readily available from the DART database [450] and Motherisk, www.motherisk.org.] The adverse effects of atenolol Selleck cancer metabolism inhibitor on fetal growth have been particularly associated with use from early pregnancy [354],

[355], [356], [357] and [358]. Whether or when to replace ACE inhibitors, angiotensin-receptor blockers (ARBs), atenolol, or less commonly used antihypertensives pre-pregnancy or when pregnancy is diagnosed, and if so, with what is uncertain, but the following should be considered: If ACE inhibitors and ARBs are being given for renoprotection, no equivalent agent is available for use in pregnancy; however, much of ACE/ARB-related renoprotection is provided lowering BP, achievable by alternatives [7]. Normally, conception may take up to 12 months, check details but women over 30 years have a higher incidence of subfertility. If an ACE inhibitor is discontinued

pre-pregnancy in a woman with renal disease, yet conception does not occur after 12 months and proteinuria is rising despite excellent BP control (i.e., <140/90 mmHg), it may be prudent to reinstate ACE inhibition, perform monthly pregnancy tests, and proceed with investigations of subfertility. A multidisciplinary approach towards comorbidities and/or cardiovascular risk factors is recommended. Although existing data are reassuring about use of statins in pregnancy, they should be discontinued pre-pregnancy or as soon as pregnancy is diagnosed until further data are available.

Information about safety with treatment at 240–336 weeks will come from the StAmP Trial (ISRCTN 23410175). For information on management of renal disease in pregnancy, see the update by Davison [451]. 1. MgSO4 is recommended for first-line treatment of eclampsia (I-A; High/Strong). For eclampsia, MgSO4 more than halves recurrent seizure rates compared with phenytoin [452], diazepam [453], or a lytic cocktail [454]. Also, MgSO4 (vs. diazepam) reduces maternal death; benzodiazepines should not be used for seizure termination. Loading is with MgSO4 4 g IV (or 5 g in South Africa) over 5 min, followed by infusion of 1 g/h. Treatment of any recurrent seizures is with another 2–4 g IV over 5 min. Serum Mg2+ levels are unnecessary, with women followed clinically for adverse Mg2+-related effects. In women mafosfamide with preeclampsia, MgSO4 (vs. placebo or no therapy) more than halves eclampsia occurrence (RR 0.41; 95% CI 0.29–0.58) [455] and [456]. Loading is with MgSO4 4 g IV over 10–15 min, followed by infusion of 1 g/h. The NNT (95% CI) to prevent one seizure is 50 (34–100) with severe preeclampsia and 100 (100–500) with non-severe preeclampsia. MgSO4 decreases abruption risk (RR 0.64; 95% CI 0.50–0.83; NNT 100 [50–1000]) but increases Caesarean delivery (RR 1.05; 95% CI 1.01–1.10) and side effects (RR 5.26; 95% CI 4.59– 6.03). MgSO4 (vs. phenytoin) reduces eclampsia (RR 0.08; 95% CI 0.01–0.60) but increases Caesarean delivery (RR 1.21; 95% CI 1.